Involuntary cough strength and extubation outcomes for patients in an ICU

Background: Removing the artificial airway is the lasl slep in the mechanical ventilation withdrawal process. In order Io assess cough effectiveness, a critical component of this process, we evaluated the involuntary cough peak flow (CPFi) to predict the exlubalion outcome for palienls weaned from mechanical ventilation in ICUs. Methods: One hundred fifty patients were weaned from ventilators, passed a spontaneous breathing trial (SBT), and were judged by their physician to be ready for extubation in the Tri-Serviee General Hospital ICUs from February 2003'to July 2003. CPFi was induced by 2 mL of normal saline solution at the end of inspiration and measured using a hand-held respiratory mechanics monitor. All patients were then extubated. Results: Of 150 enrolled patients for this study, 118 (78.7%) bad successful extubation and 32 (21.3%) failed. In the univariate analysis, there were higher Acule Physiology and Chronic Health Evaluation (APACHE) II scores (16.0 vs 18.5, F = .018), less negative maximum inspiratory pressure (-45.0 vs -39.0, F =.010), lower cough peak flows (CPFs) (74.0 vs 42.0 Iimin, P<.001), longer poslexlubalion hospital slays (15.0 vs 31.5 days, F<.001), and longer poslexlubalion ICU slays (1.0 vs 9.5 days, F